Abstract

Background Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording.

Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.

Method Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern.

Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6), child protection procedures (RR 1.4; 95% CI 1.1–1.6) and cause for concern (RR 2.5; 95% CI 1.8–3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.

Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationship

How this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial underrecording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing.

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References

Royal College of General Practitioners. Safeguarding Children & Young People: A Toolkit for General Practice 2011. Accessed: 03 Oct 2014. Available from: http://www.rcgp.org.uk/~/media/Files/CIRC/Safeguarding%20Children%20Module%20One/Safeguarding-Children-and-Young-People-Toolkit.ashx.

Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I et al. A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention. The British journal of general practice: The Journal of the Royal College of General Practitioners 2012;62(600):e478–86. Epub 2012/07/12. http://dx.doi.org/10.3399/bjgp12X652346. PMid:22781996; PMCid:PMC3381274.

National Institute for Health and Clinical Excellence. When to suspect child maltreatment (CG89)2009. Available from: http://www.nice.org.uk/CG89.

General Medical Council. Protecting Children and Young People: The Responsibilities of All Doctors, 2012.

Department for Education. Working together to safeguard children. 2013. Accessed: 03 Oct 2014. Available from: https://www.gov.uk/government/publications/working-together-to-safeguard-children.

Kumarapeli P and de Lusignan S. Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study. Journal of the American Medical Informatics Association 2013;20(e1):e67–75. http://dx.doi.org/10.1136/amiajnl-2012-001081. Epub 2012/12/18.

Royal College of General Practitioners. Safeguarding children and young people: a toolkit for general practice, 2011. Available from: http://www.rcgp.org.uk/clinical-and-research/clinical-resources/child-and-adolescent-health/safeguarding-children-toolkit.aspx.

de Lusignan S, Morris L, Hassey A and Rafi I. Giving patients online access to their records: opportunities, challenges, and scope for service transformation. The British Journal of General Practice: The Journal of the Royal College of General Practitioners 2013;63(611):286–7. Epub 2013/06/06. http://dx.doi.org/10.3399/bjgp13X668032. PMid:23735378, PMCid:PMC3662423.

National Research Ethics Service. Defining Research. 2009. Available from: http://nuhrise.org/wp-content/uploads/Defining-Research-Leaflet.pdf.

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